Since his extradition from Mexico in January after two successful prison escapes, the drug lord has been holed up 23 hours a day in an 80-square-foot cell of the Metropolitan Correctional Complex’s infamous 10 South wing.

Guzman’s new attorney Eduardo Balarezo has argued, however, that such harsh confinement could interfere with the U.S. government’s plan to put Guzman on trial come April 18.

“At this time, counsel does not allege that Mr. Guzman is not competent,” Balarezo said in a Nov. 2 letter to the court. “Rather, counsel suggests that Mr. Guzman’s condition may eventually result in a finding of incompetence if it is not addressed soon.”

Balarezo’s letter warned U.S. District Judge Brian Cogan that the strict conditions have sparked hallucinations and memory loss for his client.

“In addition to his apparent mental decline, Mr. Guzman also suffers from myriad physical problems, including constant headaches, ringing in his ears and throat pain,” the letter says. “None of these symptoms have been addressed.”

Baltimore-based neuropsychologist Cynthia Munro laid out her request to visit Guzman in a Nov. 1 letter.

“I would ideally need to have a contact visit with Mr. Guzman to facilitate my ability to establish the rapport that will encourage him to disclose sensitive personal information, but I understand that this will not be permitted,” she wrote.

Denying that request on Wednesday, Judge Cogan set the stage for Guzman’s remote examination next week.

The government let Guzman out of solitary this morning for his court hearing. Even with the help of his Spanish translator, however, the prisoner showed difficulty understanding the judge’s instructions.

Lucid enough to wish the judge “buenos días,” Guzman stumbled when asked about waiving a possible conflict of interest with his attorney.

Coached by another attorney, Guzman explained his understanding of how his attorney’s representation of a co-defendant could affect his case, before reaffirming his confidence in his counsel.

“I want Mr. Balarezo to be my attorney,” he said through a translator.

Balarezo told reporters about his client’s mental state at a press conference following the hearing.

“He has been under extremely harsh conditions, in the [special housing unit] of the MCC,” the attorney said, using an abbreviation for Metropolitan Correctional Center.

“He is basically locked up in his cell,” Balarezo continued. “He has no contact, no regular contact with anyone. His only human contact that he has is with the defense team, and though we do visit him on a daily basis, he still spends all of his day locked up in a cell with the light on, cold and it is having an effect on him.”

Guzman waved to his wife and family seated in the front row of the courtroom, but Balarezo said that the prison has not forwarded his family’s letters to him in prison.

“As I wrote in my letter to the judge, I noticed that his memory is failing,” Balarezo said. “He’s not recalling certain things, and I don’t want it to get to the point where he may be incompetent or not be able to assist the defense in preparations for trial.”